Weight maintenance
An energy deficit of 2250-4500 kJ from daily energy expenditure will allow for a 0.5-1 kg weight loss per week. This can be achieved both through decreasing energy intake and/or increasing energy expenditure. However, although weight loss can be achieved in the short-term, an issue of major importance is how to sustain this weight loss long-term.
A meta-analysis assessing long-term weight maintenance reported approximately 15 per cent of subjects undergoing weight loss interventions maintain either their reduced weight or an overall reduction of 9-11 kg at a follow-up time of up to 14 years22. When weight loss maintenance is defined as maintaining a reduction of 10 per cent of initial body weight for one year, 20.6 per cent of n=228 overweight adults in a random telephone survey were successful weight maintainers23. A weight loss strategy must therefore be sustainable in the long-term for successful maintenance of a reduced weight.
The NHMRC Clinical Practice Guidelines for the Management of Overweight and Obesity in Adults notes that the success of a weight loss strategy will be further increased with incorporation of additional principles including regular physical activity, behavioural management strategies, social support and attention to psychological adjustment including behaviour modification and stress management strategies24.
Physical activity
Incorporating moderate sustainable physical activity is highly effective and will improve both weight loss and weight maintenance. A recent Cochrane review showed that exercise combined with diet substantially increased the weight loss achieved than with diet alone25. This can include both structured exercise (at least 30 minutes per day) and incidental exercise (daily lifestyle activities such as climbing stairs whenever possible, walking greater distances (e.g. parking further away, walking during lunchtime, walking down the hall instead of emailing), gardening and house cleaning). Current public health recommendations are for 200-300 minutes per week of moderate exercise for long-term weight loss maintenance and prevention of weight regain in overweight and obese adults26.
There is also evidence that physical activity, even in the absence of weight loss, improves a range of metabolic risk factors such as hypertension, insulin resistance and impaired glucose tolerance27. Mechanistically, immediately after an acute period of exercise, glucose transport in skeletal muscle is increased through insulin-independent translocation of the GLUT4 glucose transporters to the cell membrane28. The molecular mechanisms for enhanced insulin sensitivity with exercise training may be related to increased expression/activation of key proteins in the insulin signalling pathway that regulate glucose metabolism in skeletal muscle29,30.
Behavioural modification
Psychological strategies to aid weight management focus on factors including self-monitoring, stimulus control, identifying social cues for eating, attention to appetite and hunger, regular meal patterns, portion sizes and identification of factors associated with increased food consumption. These strategies can be implemented into longer-term weight maintenance regimes through use of lifestyle modification techniques which consist of a multifaceted approach of dietary, exercise and behavioural therapies31.
Table 1: Key points for health professionals for promoting weight loss and maintenance in patients with polycystic ovary syndrome |
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Guidelines for dietary and lifestyle intervention in Polycystic Ovary Syndrome
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| 1) Lifestyle modification is the first form of therapy combining behavioural (reduction of psychosocial stressors), dietary and exercise management.
2) Smoking cessation and reduction in alcohol consumption
3) Reduced-energy diets (2250-4500 kcal/day reduction) are effective options for weight loss and can reduce body weight by 7-10% over a period of 6-12 month
4) Dietary pattern should be nutritionally complete and appropriate for life stage incorporating the following food groups
- Dairy products (low fat) 2-3 serves/day
- Bread/cereals (wholegrain/low GI) at least 3 serves/day
- Fruit at least 2 serves/day
- Vegetables at least 2 cups/day
- Meat, chicken, fish (lean) 1-2 serves/day
- Fats/oils (low saturated fat varieties) at least 3-4 teaspoons or as nuts/seeds
5) Dietary modification: <10% of calories from saturated fat, with increased consumption of fibre, whole-grain breads and cereals, and fruit and vegetables.
6) Dietary compositions with increasing dietary protein or increased unrefined carbohydrate improve reproductive and metabolic parameters equally and provide patients with increased dietary options for weight loss. Use of more satiating dietary options may be useful for achieving/maintaining weight loss.
7) Alternative dietary options (increasing dietary protein, reducing glycemic index, reducing carbohydrate) may be more successful for achieving and sustaining a reduced weight but need more research in PCOS.
8) The structure and support within a weight management program is crucial and may be more important than the dietary composition. Individualisation of the program, intensive follow-up and monitoring by physician and support from physician, family, spouse, peers support will improve retention.
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| Reprinted from an article in Reproductive BioMedicine Online by Moran et al., 2006, with permission from Reproductive Healthcare Ltd.
Adapted from32.
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Content updated 20 November, 2009
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